C95-06 Race-modified Association Between BMI and OSA Severity: Early Emergence in a Population of Adolescents Undergoing Polysomnographic Evaluation

Introduction In adults, the association between body mass index (BMI) and Obstructive Sleep Apnea (OSA) severity varies by race/ethnicity,. While increased BMI is a key driver of adolescent OSA, whether this race-specific impact of BMI emerges earlier in life remains unknown. We hypothesized that increasing BMI confers a greater odd for moderate-severe OSA among racial/ethnic minority adolescents compared to non-Hispanic (NH) White peers. Methods Retrospective review of adolescents (11-18 years old) who underwent a polysomnogram at Rady Children’s Hospital between October 2016 and April 2024. Exclusion criteria: history of neurodevelopmental, syndromic or craniofacial abnormalities. Demographic characteristics, age, BMI percentile, and PSG parameters (obstructive apnea hypopnea index, OAHI), were retrieved from the electronic health records. As a measure of social and economic neighborhood exposures, each participant’s zip-code based Childhood Opportunity Index (COI) Z-score, was obtained utilizing the COI version 2.0. Statistical analyses included chi-square tests and two sample t tests. Multivariable logistic regression was used for analysis of moderate-severe OSA (OAHI≥5), and relevant predictor variables (age, sex, 10 unit BMI percentile increase and race/ethnicity) including an interaction term for 10 unit increments in BMI percentile and race/ethnicity (compared to NH-Whites). Finally, adjusted predicted probabilities were derived from these models. Results 2741 adolescents were included, with a mean age of 14.19 (SD: 2.16) years, 56.2% were Hispanic, 23.6% NH-White, 4.5% NH-Asian/Pacific Islander (PI), 4.4% NH-Black/African American, 5.6% were NH-Other and 1.8% NH-unknown. 41.2% had moderate-severe OSA. Multivariable analysis demonstrated significant amplified effect modification by race/ethnicity on the association between BMI and Moderate-Severe OSA for Non-Hispanic Black (p < 0.01 for interaction term) and Non-Hispanic Asian/PI adolescents (p < 0.01 for interaction term) compared to NH-Whites. NH-Black/AAs experienced an 81% higher odds of Moderate-Severe OSA per 10-unit BMI increase (Odds ratio=1.81; 95% CI: 1.21-2.23), and the NH-Asians had 42% increased odds of moderate-severe OSA per 10-unit BMI increase (OR=.42; 95%CI: 1.09-1.89), versus a 14% increase for NH-White adolescents (OR = 1.14; 95% CI: 1.07-1.22). Predicted probability figures confirmed these findings, showing an exponential odds curve for both amplified groups versus a linear curve for NH-Whites, subsequently showing a cross-over section. A trend towards effect modification was seen in Hispanics (figure 1). Conclusion In an adolescent clinic population, we identified a novel modification of the effect of BMIp by NH-AA/Black and NH-Asian/PI race on their association with polysomnographically confirmed moderate-severe OSA not previously reported in this age group.